In the United States Bankruptcy Court

IN THE UNITED STATES BANKRUPTCY COURT

FOR THE MIDDLE DISTRICT OF ALABAMA

IN RE: CHAPTER 13 CASE

NO. ______-_____

______, XXX-XX-XXXX,

Debtor(s).

APPLICATION FOR APPROVAL OF ATTORNEY FEES AND EXPENSES

COMES NOW, the undersigned attorney, whose employment was approved by this Honorable Court pursuant to 11 U.S.C. §327 in the above-styled case and respectfully requests this Honorable Court to approve Attorney fees and expenses incurred in conjunction with the representation and subsequent proposed settlement of the debtor(s) claim as follows:

1. On or about ______, the Debtor(s) employed the undersigned counsel and for that representation agreed to pay the undersigned attorney fees of ___% of any recovery, plus reimbursement of reasonable expenses. The undersigned has filed an application with this Court for the approval of this employment that was granted by this Court on ______.

2. The undersigned obtained a total settlement of $______. Under the agreement executed by the Debtor(s) and approved by this Court, the undersigned is entitled to attorney fees in the amount of $______which represent ___% of the gross recovery. This contingency fee is being shared with ____ [name of referring or associated attorney], whose employment has also been approved by this Court on ____.

3. The undersigned incurred expenses of $______, consisting of $_____ for medical records, $_____ in copying expenses, and $_____ in postage during the course of handling this case.

4. The undersigned counsel has filed a motion for the approval of the settlement reached in this case.

WHEREFORE, the undersigned respectfully petitions this Honorable Court to approve his/her request for attorney fees of $______and expenses $______.

Respectfully submitted this day of , 2005.

By:

[Name of attorney] (Bar ID)

[Address]

Phone:

Fax:

Email:

CERTIFICATE OF SERVICE

I, ______, certify that I have served a copy of the foregoing APPLICATION FOR APPROVAL OF ATTORNEY FEES AND EXPENSES on the parties listed below by either electronic mail or by placing same in the United States Mail, postage prepaid and properly addressed, this day of , 2005.

[Name of attorney]

Debtor(s)

Debtor(s) Bankruptcy Attorney

Sabrina L. McKinney

Office of the Chapter 13 Trustee (Acting)

P. O. Box 173

Montgomery, AL 36101-0173

All Creditors

Teresa R. Jacobs

Bankruptcy Administrator

U.S. Bankruptcy Court

One Church Street

Montgomery, AL 36104